Provider First Line Business Practice Location Address:
1429 W. 61SST SSTREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-4515
Provider Business Practice Location Address Fax Number:
310-763-8909
Provider Enumeration Date:
02/13/2007